New Member - Is my doctor being over-cautious?

Hi all,

I'm new to MFP at the first of the year, and definitely new to being concerned about diabetes. I'd like some experienced folks thoughts before I again have a discussion with my MD.

In October, I had my first doctors visit in about two years. At the time, I was the heaviest I've ever been, mostly sedentary, and had just found I had a kidney stone, so was going through trying to pass that. (Ouch!!) My MD had a copy of my lab work the clinic did when they found the kidney stone, and decided to run blood sugar tests on me.

I'm a 60 year old male, 5' 8", and at the time weighed 188 naked. Total cholesterol is 138, LDL 58, HDL 64, and triglycerides 80 (all pretty good thanks to several years on simvastatin.) There is no history of any diabetes in my family. My goal is to reach 160 pounds by my 61st birthday in September.

My blood sugar tests showed my FPG (fasting) at 108, OGTT 2 hour test at 151, and my A1C at 5.13%. The first two barely in the pre diabetes range (100-125 and 140-200 respectively) and the AiC well into the normal range. My MD declared that I was pre diabetic, needed to lose weight, change my diet, execs, and start taking Actos.

Now the diet, weight loss, and exercise are just common sense. I've lost 13 pounds since October, have drastically modified my diet, and am getting at least some exercise. But I haven't taken any Actos. I don't like taking drugs in general, and Actos has some controversial claims. I'd rather tackle the problem with diet, weight loss, and exercise.

Well, I was in for a checkup on another matter this week, and my MD read me the riot act for not taking the meds. It was good that I'd lost weight and changed my diet. He encouraged more exercise (and I wholeheartedly agree.) But he demanded I start taking the Actos. I argued that I'm barely in the pre diabetic range, had lost weight and altered my diet, but he'd have none of it. He said "You can't avoid getting diabetes just with diet, weight loss, and exercise."

I was flabbergasted! That's exactly what the American Diabetes Association recommends to avoid getting diabetes if you are diagnosed as prediabetic! I told him about my concerns about Actos, and chose the unfortunate working of "I read on the Internet..." I might as well have said "But Dr Oz. says..." He went ballistic! "Fine, go ahead and get diabetes. Then you'll have kidney failure and I'll be amputating your feet. Go ahead and not take it, because that's what you *will* be taking when you are a diabetic!" It was like a little kid having a tantrum. He said he'd run the blood test again, but get the same results. Take the meds, or become diabetic; no other options.

This was just crazy! He's normally a very courteous and likable man, and I've been going to him for close to 30 years. I don't know what to think. Should I get a second opinion? Run the tests again? Is he right?

So I came to you folks who have a lot more experience dealing with this disease than me. I realize that my test results are well below what most folks here have and I hope you don't think I'm being disingenuous when asking for help in how to proceed.

Thanks for reading my lengthy concerns, and I appreciate any feedback,
Slo

Replies

  • JaceyMarieS
    JaceyMarieS Posts: 719 Member
    He's absolutely correct that your bloodwork indicates metabolic abnormalities and the advice to exercise, change your diet and lose weight were all standard. So he sounds just fine.

    Just fine until he whipped out his prescription pad, that is.

    If he's not going to keep up with the research, he should at least be pushing the drugs with the longest track record of effectiveness - metformin and insulin! Sure, the internet is full of kooks and quacks. However, it also gives laypeople access to medical journals and websites such as that of the FDA. Is he arguing with the warning labels??? Actos has had a black box warning since 2010(?) (2011?) due to the increased risk of bladder cancer (and maybe CHF - can't remember) Is he also aware of the warnings concerning statins and increased risk of diabetes? Or is that warning also being poo-pooed?

    Did he run the bloodwork again? What were the results the second time? Especially since your A1c was well within normal range, could the elevated FBG and OGTT be explained by the kidney stone? Illness/pain can elevate blood glucose levels.

    I would have done the same thing you did. I'd probably also be looking for a new doctor if I felt my (reasonable) questions/concerns were not being addressed professionally.
  • Scubanana7
    Scubanana7 Posts: 361 Member
    I think you are smarter than the doc. I would NOT take the med. I would try another doctor and get your bloodwork redone. You are not obese. Most of your numbers are awesome. Yes, you need to be aware of prediabetes, yes, you need to eat right and exercise, yes, you need to drop a few pounds (and you did great). I am diabetic and been on metformin for years. My doctor, thankfully has had the great sense to not play around with my meds. My sister's doc gives her every new drug on the market and is constantly changing her around. She is so 'happy' with her A1c. I am HAPPY with mine. I take metformin twice/day. She takes 3 meds 3 times a day. Go figure! and she was on Actos for a while but I think she is off that now.

    Sounds like you are headed in the right direction. Get a new doctor and keep up the good work! I am surprised he didn't think you gained a few pounds because you were depressed and that you should take antidepressants to! lol--definitely a drug pusher.
  • BigGuy47
    BigGuy47 Posts: 1,768 Member
    I don't like taking drugs in general, and Actos has some controversial claims. I'd rather tackle the problem with diet, weight loss, and exercise.
    I don't care for taking drugs either. I took metformin for a year, I was able to get off the medication by controlling my diet and exercising regularly.

    ...he demanded I start taking the Actos.
    I don't like the tightly intertwined relationship between pharmaceutical reps and doctors. My wife worked in doctors offices for many years. Everyday there was a steady stream of drug reps coming to the office. They would often bring in breakfast or lunch for the entire office. The doctors were offered stipends for speaking events sponsored by the pharmaceutical companies. The physicians were invited to educational conferences at lavish resorts that were paid for by the drug companies. In short, there's an incredible amount of incentives offered to physicians that have good relationship with the pharmaceutical companies. Maybe your doctor had to get just one more patient taking Actos to qualify for the trip to Aruba. You ruined his plans.

    For years my blood pressure was controlled using a cheap generic medication. Every time I went to my physician I was pressured to take the new bp meds that were available. My bp numbers were solid, no reason to change meds and yet my doc insisted that these new meds were better (although not yet available as a generic). I refused to take the new "better" meds. Again, from weight loss, diet and exercise I no longer take bp meds. I no longer see that doctor either (was my doc for 20 years).
    I've been going to him for close to 30 years. I don't know what to think. Should I get a second opinion?
    I assume that he's a general practitioner. I would get a second opinion. I was fortunate to find a internal medicine doctor that specialized in diabetes. From day one he encouraged me to control my diet, lose the weight and exercise on a regular basis. He did prescribe metformin because my blood glucose level was off the charts initially, but never pushed any other drugs. After I got my bgl under control he was pleased to tell me that I no longer needed to take metformin.

    Do some research and find a doctor that has some experience with diabetes. At the end of the day you are the best advocate for your own health. Far too many people blindly trust doctors that are ill informed or have motives that are in their own self interest.
  • retiree2006
    retiree2006 Posts: 968 Member
    I agree that you might want to look for a new doctor with better knowledge of diabetes. You've done well with diet and exercise and are to be commended with taking the lead on improving your own health. My doctor was thrilled with my improvements and has worked with me to decrease some meds. Keep researching...but also talk to others with similar issues and get some recommendations for a different doctor. I prefer someone who will help me prevent or improve issues rather than fix everything with a pill.

    Keep up the wonderful work!
  • jknops2
    jknops2 Posts: 183 Member
    Find a new doctor. First choice drug is Metformin not Actos. Metformin is cheap, helps you respond better and has no major side effects. But your numbers are borderline.
  • scubasuenc
    scubasuenc Posts: 626 Member
    On the plus side you have a doctor who is concerned. I went the doctor for years and she never said anything when my blood glucose was in the pre-diabetic range. When my A1C hit 7, she said I was diabetic and I should lose weight and diet and exercise..... Needless to say I switched doctors.

    Metformin seems to be the drug of choice as the starting medication. I do know doctors that put people on it during the pre-diabetic phase. However since you were at the low end of the range, there is no guarantee another doctor would recommend any medications.

    I'd definitely get a second set of tests and a second opinion.
  • Thank you everyone for your thoughtful and helpful replies!

    To answer one of the questions; no, my MD (yes, a general practitioner) did not run another set of tests after I'd lost weight and was no longer stressed from the kidney stone. He said it would be the same, and wasn't worth doing. Discount Drug Mart around here does free weekly blood glucose screenings. I'm not sure what that tests for, but I may stop in and have that done just for my own curiosity.

    As I said, this is so out of character for him! He's always been pro-active, and has not been pushing pills up until now. An example: When I had the kidney stone, the urologist had a CT scan, and sent the results to my MD. My MD read the report, and based on plaque buildup in the abdominal arteries, decided that there was likely buildup in my heart as well, and had me do a stress test (my first ever.) From that, he sent me to a cardiologist, who looked at the reports and had me in hospital two days later for a heart cath and inserted a stent. I was 90% blocked and had no symptoms or any indication there was anything wrong. That was two weeks ago, and now I'm doing cardiac rehab and loving the exercise! That's the doctor I've known and appreciated over the years.

    Needless to say, learning to avoid the fats and salt for the heart health and the cabs and the sugar for the diabetes avoidance is a new and frustrating learning experience. But it is certainly worth doing and I'm determined to make it a permanent change!

    I think I'll continue not taking the drugs. I'm definitely continuing with the change of diet, weight loss, and exercise.

    Thank you all so much,
    Slo
  • scubasuenc
    scubasuenc Posts: 626 Member
    You said your last A1C test was in October. Well, the A1C is a way of measuring your blood sugar over the last three months. It is weighed more heavily to recent blood sugar level. Given your weight loss, diet and exercise changes it is quite possible your A1C has dropped.

    You can also get an A1C test at the drug store for about $20. However I've heard mixed reviews on the accuracy of those tests compared to lab tests. That might be the test they use at the free screening clinic.
  • cathylopez1975
    cathylopez1975 Posts: 191 Member
    Find a new doctor. First choice drug is Metformin not Actos. Metformin is cheap, helps you respond better and has no major side effects. But your numbers are borderline.

    This! I had a primary care doc that just threw drugs at the problem, too. But at least he started with Metformin then added other meds to lower BG more. He had no knowledge of diabetes really. I am 13 years diabetic and finally went to an endocrinologist to get help. Best thing I ever did. You just need a doc who knows diabetes
  • awelmore
    awelmore Posts: 13 Member
    I also recommend finding an endocrinologist. This is not to replace your current doctor, but in addition to him. My endo changed my meds from Actos to metformin and I am so glad she did. The fewer meds you can take the better. An endo can also make sure you get any other doctor visits, nutritionists, and/or other experts when and if you need them.

    It sounds like you are on the right track with dieting and exercise. Keep up the good work!
  • fishbarn
    fishbarn Posts: 90 Member
    You can control your blood sugar levels with diet & exercise. So I would suggest you find a Dr that will work with you on your diet & exercise program not against you.